Insurance Still a Struggle a Year After AdultBasic Nixed

When Rick Mossinghoff lost his AdultBasic health insurance coverage, he was in the midst of physical therapy appointments for arthritis in his hip.

As Gov. Tom Corbett suggested to the more than 40,000 people who lost that coverage, Mossinghoff enrolled in the Special Care program.

And he found out that, in addition to it being higher in cost, it didn’t cover the therapy sessions and limited his doctor’s appointments to four each year.

When he went had to later undergo a hip replacement, the Special Care program initially only authorized a one-day hospital stay. While groggy from sedation, Mossinghoff, of Robinson Township, said he had to talk with hospital staff and insurance representatives to get the situation figured out.

It was only on his fifth day in the hospital that he discovered that his request for that coverage had been granted.

Mossinghoff was one of several speakers to lament the loss of the adultBasic program one year ago.

“Special Care has been a nightmare for me,” he said. “For this we pay over four times what we did for adultBasic.”

Such anxiety and financial pressures are common, and many are allowing chronic health conditions to go untreated, health care providers, advocates and former adultBasic enrollees said during a media conference call hosted by the Pennsylvania Health Access Network Wednesday.

"By ending adultBasic, Governor Corbett took away the only affordable health care option for thousands of hardworking Pennsylvanians," said Erin Gill-Ninehouser of PHAN. "This has put the health, security and well-being of many Pennsylvania families at risk."

Until February 2011, adultBasic offered affordable health coverage to low-income working Pennsylvanians who either lacked access to job-based coverage or were denied outright because of pre-existing health conditions.

A funding agreement reached with the state's four Blue Cross/Blue Shield plans had expired, creating a funding shortfall. Corbett opted to end the program rather than renegotiate the agreement.

The Blues' plans, meanwhile, continued to do quite well despite the recession. Reports show the plans had a combined surplus of $6.4 billion in 2010, said Sharon Ward, Director of the Pennsylvania Budget and Policy Center.

Dr. Cheryl Bettigole, a physician and safety-net provider from Philadelphia, talked about the increasing number of people who are turning to free clinics to treat their health conditions after losing adultBasic or the health coverage they once had through work.

"We've seen more and more people with chronic conditions—diabetes, high blood pressure, heart disease—going without care because they lost their adultBasic coverage, putting them at high risk of complications including kidney disease and heart problems," Bettigole said."Many more people coming in are uninsured for the first time—after losing their job, or seeing their hours reduced to part-time—especially in the last three years. Now you're adding to that this group of folks who lost adultBasic. This has been a huge loss for us."

Leslie Bachurski, who fields calls from uninsured people in the Pittsburgh area as the Consumer Health Coalition's healthcare navigator, agreed. She said that calls to the helpline have risen by 75 percent since 2009—and by 40 percent alone in the months after adultBasic ended.

"Without adultBasic, many have been forced to seek care at emergency rooms or overwhelmed clinics," she said.

Ward, of the Pennsylvania Budget and Policy Center, said during the six months after adultBasic ended, fewer than 40 percent of those who lost their health coverage enrolled in the state's Medical Assistance Program or the Blues' Special Care Plan touted as an alternative by Corbett.

"We don't know what happened to the other 60 percent," Ward said. "Many of them have simply fallen through the cracks."

Some predicted that by September more former enrollees would sign up for PA Fair Care, the state's new insurance option for people with pre-existing health conditions. That program, funded by the federal Affordable Care Act, requires that enrollees be uninsured for at least six months. But Ward noted that there was no significant uptick in enrollment after September, when former enrollees became eligible.

Advocates said Special Care has not been a viable option for former adultBasic enrollees, especially in light of a recent rate hike and increase in co-pays and cost-sharing. And despite the heroic efforts of overburdened safety net providers, thousands of former adultBasic enrollees continue to go without access to critical medical care.

"The Affordable Care Act is the only light at the end of the tunnel for those who lost adultBasic, and the 1.4 million Pennsylvanians who are currently uninsured," said Gill-Ninehouser of PHAN. "Policymakers must move forward implementing it so that Pennsylvania families can access the kind of choices and security that don't exist in our current health insurance market."

Editor’s Note: The Pennsylvania Health Access Network is a coalition of 50 groups from across the Commonwealth working to improve access to quality health care through the expansion of health insurance coverage.